Spatial barriers and the bypassing of nearby dental clinics for dental services: a secondary data analysis in Korea

OBJECTIVE: This study aimed to calculate the distance patients travel to dental clinics, the rate of bypassing nearby dental clinics and the distance covered when bypassing nearby dental clinics, and explored factors associated with patients’ spatial access to dental clinics. DESIGN: A secondary data analysis. SETTING: Korea Health Panel. PARTICIPANTS: We included users of dental care services from 2008 to 2011. A total of 2375 patients and 15 978 dental visits were analysed. PRIMARY OUTCOME MEASURES: Korea Health Panel data (2008–2011) were used to geocode patients’ and healthcare facilities’ addresses. The distance travelled was calculated using road network information. To analyse the panel data, we adopted a generalised estimating equation: geographical measures on the choice of dental care facility were examined based on sex, age, educational level, equivalent income, treatment details and regional classification. RESULTS: The median distance travelled to a dental clinic was 1.8 km, which is farther for rural (8.4 km) than for urban (1.5 km) patients. The bypass rate was 58.9%. Patients bypassing nearby dental clinics travelled 9.6 times farther for dental care (p<0.001). Unlike bypass distance, travel distance was not associated with equivalent income. People with higher education and those with implants/orthodontic treatment were more likely to bypass nearby dental clinics and travelled 1.27 times and 1.17 times farther (p<0.01), respectively. CONCLUSIONS: Given the spatial barrier to available dental resources, factors associated with spatial access were mostly the same between travel and bypass distance except for equivalent income. The findings of this study suggest that spatial distance acts as a utilisation barrier and demands additional opportunity cost. At the same time, patients’ preferences for services also increase their willingness to bypass nearby dental clinics and travel greater distances.